早期胃癌保功能手术治疗13例病例分析

Analysis of 13 cases of early gastric cancer treated with functional preservation surgery

目的:探讨早期胃癌保功能手术治疗的可行性、安全性及其短期疗效。方法:回顾性分析2021年3月至2022年8月同一手术团队开展的13例早期胃癌保功能手术患者的临床资料。数据采用SPSS 25.0软件进行分析,正态分布的计量资料采用(^(-)x±s)表示,行独立样本t检验,偏态分布的计量资料采用M表示;计数资料以[例(%)]表示,采用χ^(2)检验。以P<0.05为差异有统计学意义。结果:13例患者均成功完成了保功能手术,肿瘤均完整切除,手术时间(183±25)min,术中出血量(103±37))ml,淋巴结清扫数量中位数为11枚;术后肛门排气时间(1.9±0.7)d,排便时间(3.0±0.8)d;术后住院时间(6.3±1.4)d。术后病理报告:1例患者淋巴结病理结果提示有癌转移(2/14);基底切缘阳性1例。术后1例行保留幽门的胃切除术(PPG)患者出院后出现胃潴留,经再次入院保守治疗后好转出院,1例行内镜下黏膜剥离术(ESD)+D1淋巴结清扫患者病理结果提示标本基底有癌浸润,出院后2个月追加全胃切除术,追加手术病理结果为阴性。随访术后1个月及3个月患者营养状况及生活质量评估,结果显示所有患者生活质量均较好,无需额外行营养支持。结论:早期胃癌保功能手术为患者精准切除了肿瘤病灶,最大限度地保留了胃的功能,创伤小、康复快,使患者术后具有较好的生活质量。因此,合理掌握其适应证与手术技巧,保胃功能手术是安全可行的。

Objective To investigate the feasibility,safety and short-term efficacy of functional preservation surgery for early gastric cancer.Methods The clinical data of 13 patients who underwent functional preservation surgery for early gastric cancer performed by the same surgical team from March 2021 to August 2022 were retrospectively analyzed.Results All the 13 patients successfully completed functional preservation surgery,complete resection of tumors,operation time:[(183±25)min],intraoperative blood loss:[(103±37)ml],median lymph node dissection:11.Postoperative anal exhaust time:[(1.9±0.7)d],defecation time:[(3.0±0.8)d];Postoperative hospital stay:[(6.3±1.4)days].Postoperative pathological report indicated that 1 case of lymph node pathology indicated cancer metastasis(2/14).The basal margin was positive in 1 case.Postoperative gastric retention occurred in 1 patient who underwent PPG surgery and was discharged after conservative treatment after re-admission.Pathological results of 1 patient who underwent ESD+D1 lymph node dissection indicated carcinoma infiltration in the specimen base.Total gastrectomy was performed 2 months after discharge,and the pathological results of additional surgery were negative.The nutritional status and quality of life of patients were evaluated at 1 and 3 months after the follow-up.The results showed that all patients had a good quality of life and did not require additional nutritional support.Conclusion Functional preservation surgery for early gastric cancer accurately excizes the tumor lesion for the patient,preserves the function of the stomach to the maximum extent,has less trauma,fast recovery,and enables the patient to have a better quality of life after surgery.Therefore,it is safe and feasible to properly master the indications and surgical techniques of gastric function preservation surgery.